Inspection Summary

Overall summary & rating

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shashi Arora’s practice (also known as Baring Road Medical Centre on 22 March 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events, although the policy for managing such issues lacked specific detail.

Risks to patients were assessed and well managed.

Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

Information about services and how to complain was available and easy to understand.

Patients said they found it difficult to make an appointment with a named GP and that routine appointments were not always immediately available. However, there were urgent appointments available the same day.

The practice had good facilities and was well equipped to treat patients and meet their needs.

There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on in some cases.

The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

The practice should ensure that all clinical staff have DBS checks. If non-clinical staff are not DBS checked then a risk assessment as to why this is not required must be in place.

The practice should review its appointments systems, and telephone answering service in line with feedback from patients that we spoke to, comment cards that we received and the national patient survey which said that telephone waits were long and appointments difficult to access.

The practice should consider reviewing it’s diabetes management processes to seek ways to improve its patient outcomes in this area against national figures.

The practice should ensure that the seats in the reception area are free from tears to ensure that they are not an infection control risk.

The practice should ensure that floor covering on stairs are firmly attached so that in future they do not become a trip hazard.

The practice should review it’s policies to ensure that they are thoroughly documented, specifically detailing how and when the policy should be used, and what actions should be taken. In particular the serious untoward events policy and fire prevention policies should be reviewed.

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Inspection areas

Safe

There was an effective system in place for reporting and recording significant events, but the practice policy for managing events lacked some specific detail.

Lessons were shared to make sure action was taken to improve safety in the practice.

When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

Risks to patients were assessed and well managed.

At the time of the visit some clinical staff had not received Disclosure and Barring Service (DBS) checks, although they had been requested.

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Effective

Good

Updated 27 May 2016

The practice is rated as good for providing effective services.

Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average in most areas. However, diabetes outcomes for the last year were below national averages.

Staff assessed needs and delivered care in line with current evidence based guidance.

Clinical audits demonstrated quality improvement.

Staff had the skills, knowledge and experience to deliver effective care and treatment.

There was evidence of appraisals and personal development plans for all staff.

Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

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Responsive

Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

The practice had good facilities and was well equipped to treat patients and meet their needs.

Feedback from patients reported that access to a named GP and continuity of care was not always available quickly. They stated that routine appointments were not readily available, although urgent appointments were usually available the same day.

Patients reported that telephone access for the practice was subject to long waits.

Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

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Well-led

The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.

There was a clear leadership structure and staff felt supported by management.

The practice had a number of policies and procedures to govern activity and held regular governance meetings. However, the governance documents that we reviewed lacked some specific detail, most notably those for fire safety and the management of serious untoward events.

There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

The practice proactively sought feedback from staff and patients. We saw from the patient participation group that the practice had been quick to suggest improvements. However, the practice had not proactively reviewed other patient surveys, and we were told that routine appointments were still difficult to access.

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Checks on specific services

People with long term conditions

The practice is rated as good for the care of people with long-term conditions.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

Performance for diabetes related indicators was lower than the CCG and national average. The practice had scored 71% in QOF with a total of 61of 86 points scored. The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months was 67%, compared to a national average of 77%. The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 69% compared to a national average of 81%.

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Families, children and young people

Good

Updated 27 May 2016

The practice is rated as good for the care of families, children and young people.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

The practice’s uptake for the cervical screening programme was 76%, which was comparable to the the national average of 82%.

Appointments were available outside of school hours and the premises were suitable for children and babies.

We saw positive examples of joint working with midwives, health visitors and school nurses.

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Working age people (including those recently retired and students)

Good

Updated 27 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

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People experiencing poor mental health (including people with dementia)

Good

Updated 27 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

74% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average/ worse than the national average.

Performance for mental health related indicators was similar to the CCG and national average. The practice had attained 81% of the available QOF points, scoring 21 of 26 points. The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 74%, compared to a national average of 84%. A comprehensive care plan was in place for 80% of patients, compared to 79% within the CCG and 75% nationally.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Staff had a good understanding of how to support patients with mental health needs and dementia.

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People whose circumstances may make them vulnerable

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

The practice offered longer appointments for patients with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.